101
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Abstract
Giant cell arteritis, which is probably due to disturbed immune mechanisms, has a spectrum of clinical symptoms in elderly people. In nearly all cases such general signs as loss of appetite, loss of weight and fever are present. The sedimentation rate is almost without exception about 100 mm in the first hour. The two most frequent and typical clinical syndromes are polymyalgia rheumatica and cranial arteritis. The polymyalgia rheumatica is characterized by periarticular pain which is mostly symmetrical and accentuated in the shoulder girdle. Increasingly severe temporal headache and ocular distrubances are found with cranial arteritis in more than 50% of cases. A combination of both diseases is frequent. Other arterial branches are rarely involved. The course of the disease is over a period of 1 1/2 to 2 years. Treatment with corticosteroids is indicated mainly because of the severe ocular complications with blindness. It should begin immediately, be intensive and last over a long period. Regular followup is necessary over several years in order to avoid relapses.
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102
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Hazleman B, Goldstone A, Voak D. Association of polymyalgia rheumatica and giant-cell arteritis with HLA-B8. BRITISH MEDICAL JOURNAL 1977; 2:989-91. [PMID: 922399 PMCID: PMC1631778 DOI: 10.1136/bmj.2.6093.989] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Histocompatibility antigens were determined in 30 patients with temporal arteritis, 27 patients with polymyalgia rheumatica, and 216 normal blood donors. HLA-B8 was significantly more common in patients with polymyalgia rheumatica (59%) and temporal arteritis (50%) than in the controls (27%). The findings of HLA-A10 in 26% of the patients with polymyalgia rheumatica compared with only 10% of the controls may be associated with the suggested immunological pathogenesis of the condition.
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103
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Svendler CA, Söderlundh S. Angiographic diagnosis in polymyalgia arteritica. ACTA RADIOLOGICA: DIAGNOSIS 1977; 18:333-8. [PMID: 331879 DOI: 10.1177/028418517701800309] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Angiography of the main branches of the thoracic aorta was performed in 20 patients with the clinical diagnosis of polymyalgia arteritica. Lesions were mainly observed in the subclavian and axillary arteries, sometimes also in their branches. The angiographic and pathologic appearances of the lesions as well as differential diagnostic considerations are presented.
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104
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105
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LANDE ADAM, BERKMEN YAHYAM. AORTITIS. Radiol Clin North Am 1976. [DOI: 10.1016/s0033-8389(22)01736-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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106
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Abstract
Polymyalgia rheumatica should be considered when a syndrome of constitutional symptoms, especially weight loss, low-grade fever, weakness, wasting proximal muscles, fatigue, malaise and depression, is seen in the elderly. Giant-cell arteritis plays a part later in the course. Thus the need for biopsy of a long segment of the temporal artery to help in determining diagnosis and therapy. An elevated erythrocyte sedimentation rate (ESR) is an important clue. The usual high value is about 80 mm/hour; if it is over 100 mm/hour, giant-cell arteritis should be suspected. Salicylates, indomethacin, phenylbutazone and hydroxychloroquine produce some clinical improvement but do not lower the high ESR; moreover, the patients are prone to experience relapses. Prednisone, however, not only produces clinical improvement but lowers the high ESR. Potassium p-aminobenzoate may be useful in maintaining the remission.
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107
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Abstract
The incidence of abnormal results in liver function tests was determined in 37 of 51 patients with polymyalgia rheumatica (PMR) or temporal arteritis. Fine-needle biopsies fo the liver were performed on 6 of these patients and the bile canalicular network and liver cytology were studied in the aspirate by enzyme-cytochemical methods. Of the 37 patients in whom it was measured, 23 (62%) had elevated concentrations of serum alkaline phosphatases (AP), mainly of hepatic origin. The concentrations of other serum enzymes associated with hepatic function were normal in all 37 patients. BSP retention was studied in 13 patients and was abnormal in 6 (46%). Three of the 4 patients for whom smears were stained for AP activity had an increase in this activity in their bile canaliculi that corresponded to a rise in the serum concentration of AP. In one of these 3 patients, smears stained for naphthylamidase showed that bile canaliculi had a calibre wider than normal and had granular walls. A second biopsy performed 10 days showed a partial reversal of these changes. Mild fatty infiltration of the liver cells was seen in 2 patients; one patient whose serum concentration of AP was normal also had normal liver cells and bile canaliculi. The structural changes in the bile canaliculi detected in one patient may be evidence of a subclinical hepatic disease associated with PMR. The cholestatic hepatic dysfunction, common in PMR and manifested in over half of our patients by elevated serum AP levels, can easily be confirmed with special staining methods for visualizing the bile canaliculi in cytological liver specimens.
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108
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von Knorring J, Selroos O. Sarcoidosis with thyroid involvement, polymyalgia rheumatica and breast carcinoma. A case report. Scand J Rheumatol 1976; 5:77-80. [PMID: 935826 DOI: 10.3109/03009747609099894] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Polymyalgia rheumatica developed in a 71-year-old patient within 2 years of the onset of acute sarcoidosis with biopsy-verified involvement of the thyroid, and concomitant autoimmune thyroiditis with hyperthyroid symptoms. Three years after the onset of muscle symptoms a non-metastasizing breast carcinoma was discovered and treated surgically. Neither the long interval between the onset of polymyalgia rheumatica and the discovery of the breast tumour, nor the good response of muscle symptoms to a one-year maintenance treatment with corticosteroids, was consistent with a paraneoplastic mechanism of the polymyalgia rheumatica syndrome. It was therefore hypothesized that the various disorders suffered by this patient might be related to a partly age-dependent depression of T-lymphocyte function, leading to an altered immunological reactivity to which the various clinical manifestations could be attributed. Such a hypothesis is supported by recent reports showing that in old people and in ageing experimental animals, a decrease in T-lymphocyte function and in the number of circulating T-cells occurs concomitantly with an increase in the incidence of a variety of neoplasms and autoimmune disorders.
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109
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Hart FD. Inflammatory disease and its control in rheumatic disorders. BRITISH MEDICAL JOURNAL 1975; 4:191-4. [PMID: 1081416 PMCID: PMC1674977 DOI: 10.1136/bmj.4.5990.191] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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110
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Abstract
Thirteen patients with polymyalgia rheumatica (P.M.R.) were examined for evidence of viral infection. Hepatitis-B surface antibody (HBsAb) was detected in nine out of twelve patients tested prior to therapy. The antibody persisted up to six months in four patients but reverted to negative in the other five. HBsAb was found in only one of twelve age-matched controls. Hepatitis-B surface antigen was not detected in any patient or control. No significant elevation of antibody titre was detected to a panel of twelve other organisms. Immunoglobulin levels were elevated prior to treatment in several patients. With steroid therapy the IgG and IgA levels fell serially but the IgM levels increased in six patients. These results suggest that hepatitis B is an important trigger for P.M.R. In view of the association with giant-cell arteritis, P.M.R. may represent an abnormal immunological response to infection in elderly patients.
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111
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113
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Liang GC, Simkin PA, Hunder GG, Wilske KR, Healey LA. Familial aggregation of polymyalgia rheumatica and giant cell arteritis. ARTHRITIS AND RHEUMATISM 1974; 17:19-24. [PMID: 4810661 DOI: 10.1002/art.1780170105] [Citation(s) in RCA: 70] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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114
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115
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Paulsen S, Iversen TO. Rheumatic polymyalgia. Long-term treatment with steroids. ACTA RHEUMATOLOGICA SCANDINAVICA 1971; 17:165-8. [PMID: 4999279 DOI: 10.3109/rhe1.1971.17.issue-1-4.22] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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116
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Abstract
Anderson, J. A. D. (1971).Brit. J. industr. Med.,28, 103-121. Rheumatism in industry: a review. Information about causes, effects, and prevention of rheumatic disease among industrial workers lacks standardization, as shown by the literature in this field; one reason for this is that there are discrepancies about the range of diseases and syndromes which should be included under this heading. The Industrial Survey Unit of the Arthritis and Rheumatism Council defined a rheumatic complaint as musculo-skeletal pain not related to recent (i.e., within six weeks) trauma. A study by the Unit of the social and economic effects of rheumatism among 2 684 male employees from a range of manual occupations is considered in relation to the observations made by other investigators. Sickness absence (at present estimated to be about 29·8 million working days per annum in Britain) and premature retirement can be shown to result directly from rheumatic complaints, especially rheumatoid arthritis and disc disease; furthermore, there seems to be general agreement that sickness absence is more marked in heavy manual occupations than in light ones. However, the extent to which job changes ascribed to rheumatic complaints are in fact caused by them is more doubtful. Evidence supporting the view that occupational factors are related to the aetiology of some chronic rheumatic diseases is fairly strong. Chronic tenosynovitis, bursitis, osteoarthrosis, and, to a lesser extent, disc disease are among those in which such a relationship can be demonstrated; however, the reason why some men are more prone to develop these conditions than others working in similar jobs is still in doubt, suggesting that the aetiology is multifactorial. In other rheumatic diseases, notably rheumatoid arthritis, a fairly extensive study of the literature does not indicate any clear correlation between occupation and aetiology. A system of job analysis for individual workers based on effort, posture, and climatic conditions at work is suggested. Its use as an alternative to grouping employees under their occupational titles might help to clarify these points. Prevention of rheumatic disease (including the use of pre-employment medical examinations) seems impracticable at the present time, but some progress in tackling the problems of rheumatism among industrial workers might be possible by improving rehabilitative services. These improvements would depend on closer collaboration not only between government departments but among doctors themselves and between them and others working in this field.
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117
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Goodman MA, Pearson CM. Polymyalgia rheumatica and associated arteritis: A review. Calif Med 1969; 111:453-60. [PMID: 5358979 PMCID: PMC1503729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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118
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119
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Dixon ASJ. Polymyalgia Rheumatica. JOURNAL OF THE ROYAL COLLEGE OF PHYSICIANS OF LONDON 1969; 4:55-61. [PMID: 30667736 PMCID: PMC5367169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- A. St J. Dixon
- Physician, St Martin's Hospital, and Royal National Hospital for Rheumatic Diseases, Bath
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Easterbrook WM, Baxter DW, Martin JR. Temporal arteritis developing during indomethacin therapy of polymyalgia rheumatica. CANADIAN MEDICAL ASSOCIATION JOURNAL 1967; 97:296-9. [PMID: 6029251 PMCID: PMC1923224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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125
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126
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von Knorring J, Erma M, Lindström B. The clinical manifestations of temporal arteritis. ACTA MEDICA SCANDINAVICA 1966; 179:691-702. [PMID: 4161294 DOI: 10.1111/j.0954-6820.1966.tb05494.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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127
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Nuessle WF, Miller HE, Norman FC. Polymyalgia rheumatica, giant-cell arteritis and blindness: a review and case report. J Am Geriatr Soc 1966; 14:566-77. [PMID: 5327767 DOI: 10.1111/j.1532-5415.1966.tb04087.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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128
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Dixon AS, Beardwell C, Kay A, Wanka J, Wong YT. Polymyalgia rheumatica and temporal arteritis. Ann Rheum Dis 1966; 25:203-8. [PMID: 5931550 PMCID: PMC2453392 DOI: 10.1136/ard.25.3.203] [Citation(s) in RCA: 65] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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129
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Terwindt VA, Knoben JM. Polymyalgia rheumatica, arteritis and hepatic damage. ACTA MEDICA SCANDINAVICA 1966; 179:307-18. [PMID: 5910849 DOI: 10.1111/j.0954-6820.1966.tb05463.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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130
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Polymyalgia rheumatica. BRITISH MEDICAL JOURNAL 1966; 1:496-7. [PMID: 5902693 PMCID: PMC1843768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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131
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132
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Chapman BL, Holland JT. POLYMYALGIA RHEUMATICA: REPORT OF TWO CASES. Med J Aust 1965. [DOI: 10.5694/j.1326-5377.1965.tb19319.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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134
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BARKER JC. POLYMYALGIA. BRITISH MEDICAL JOURNAL 1964; 2:646-7. [PMID: 14171089 PMCID: PMC1815742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
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135
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136
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LEVEY GS, CAREY JP, CALABRO JJ. Polymyalgia rheumatica: A separate rheumatic entity? ACTA ACUST UNITED AC 1963; 6:75-7. [PMID: 13930072 DOI: 10.1002/art.1780060109] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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137
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GOWER ND. Pyrexia of undetermined origin. A syndrome of intermittent fever, anaemia, and raised erythrocyte-sedimentation rate. Lancet 1963; 1:124-6. [PMID: 13949638 DOI: 10.1016/s0140-6736(63)91014-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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138
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Polymyalgia Rheumatica. CANADIAN MEDICAL ASSOCIATION JOURNAL 1962; 86:958. [PMID: 20327129 PMCID: PMC1849230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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139
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140
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141
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Boyle AC, Beatty DC. Polymyalgia Rheumatica. Proc R Soc Med 1961; 54:681-684. [PMID: 19994125 PMCID: PMC1870384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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142
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POLYMYALGIA rheumatica. BRITISH MEDICAL JOURNAL 1957; 2:1483-4. [PMID: 13489270 PMCID: PMC1962941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
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